A clinical audit of antithrombin concentrate use in a tertiary paediatric centre

Abstract

This data provides the basis for future investigations of the specific biochemical changes accompanying ATC administration and the development of paediatric-specific evidence-based guidelines for ATC use.

Antithrombin Concentrate in Pediatric Patients Requiring Unfractionated Heparin Anticoagulation

“…Mean UFH doses to achieve a target anti-factor Xa activity pre-and post-ATC administration were 28 (95% CI, 24-32) and 19 U/kg/hr (95% CI, [16][17][18][19][20][21][22], respectively, for children 12 months old or younger (p < 0.0001) and 25 (95% CI, [19][20][21][22][23][24][25][26][27][28][29][30] and 19 U/kg/hr (95% CI, [11][12][13][14][15][16][17][18][19], respectively, for children older than 12 months (p < 0.001). The anti-factor Xa activity preand post-ATC administration was 0.21 (95% CI, 0.17-0.25) and 0.47 U/mL (95% CI, 0.37-0.57), respectively, for children 12 months old or younger (p < 0.0001) and 0.24 (95% CI, 0.13-0.35) and 0.31 U/mL (95% CI, 0.23-0.39), respectively, for children older than 12 months (p = 0.07) ( Table 2).…”

Antithrombin III Doses Rounded to Available Vial Sizes in Critically Ill Pediatric Patients

“…5 Exogenous AT III is often administered to patients with AT III deficiency who are receiving heparin infusions in an effort to increase efficacy of heparin, thus lowering the heparin infusion rates required to achieve therapeutic partial thromboplastin time or activated clotting time. 3,8 Additionally, higher AT III levels can result in more effective low-molecular-weight heparin doses. 10 The formulary AT III product at this institution is Thrombate III (Grifols, Research Triangle Park, NC).…”

“…The result is potential for a large amount of waste. 3 Safely rounding doses in young patients to available vial sizes may lead to cost savings.…”

“…[1][2][3] Thrombate III (Grifols, Research Triangle Park, NC) is a preparation of human AT III which is indicated in treating hereditary antithrombin deficiency. 4 Although AT III is indicated only for hereditary antithrombin deficiency in adults, a recent review of AT III use in children less than 18 years of age found that 97% of patients received AT III for indications other than congenital antithrombin deficiency.…”

“…Due to a short stability of 3 hours, each vial of AT III will most likely only be used to prepare a single dose. 3,4 When administering doses of AT III, the manufacturer recommends monitoring plasma AT III levels in order to achieve a target between 80% and 120%. 4 An AT III level < 80% after AT III dose administration often results in prescribing of additional doses at this institution.…”